Outcome of Endoscopic Repair of Nasal Septal Perforation

Abstract

Introduction: The anterior ethmoidal artery (AEA) flap has been demonstrated to be a reliable option for endoscopic repair of symptomatic nasal septal perforations. The purpose of this study is to study the outcome of this technique. Methods: A retrospective case series of all consecutive patients who underwent repair of nasal septal perforation utilizing the AEA flap among 2 institutions from August 2020 to July of 2022 was conducted. Demographics and comorbidities were collected preoperatively and postoperatively. The main outcome of this study was to identify the risk factors for surgical failure. Results: Forty-one patients were included. Mean perforation size was 2.2 cm (range 0.5-4.5 cm). Mean age was 42.5 years (range 14-65 years), 53.6% were female, 39% were active smokers, mean body-mass-index (BMI) was 31.9 (range 19.1-45.5), 20% with history of CRS and 31.7% had diabetes mellitus (DM). Etiologies of the perforation included idiopathic (n = 12), iatrogenic (n = 13), intranasal drug use (n = 7), trauma (n = 6), and secondary to tumor resection (n = 3). Overall success rate for complete closure was 73.2%. Active smoking, history of intranasal drug use, and DM were significantly associated with surgical failure (72.7%vs 26.7%, P = .007; 36.4%vs 10%, P = .047; and 63.6%vs 20%, P = .008 respectively). Conclusion: The endoscopic AEA flap is a reliable technique for closure of nasal septal perforation. It may not work when the etiology is intranasal drug use. Close attention to diabetes and smoking status is also needed.

Cadaveric and Computed Tomography Analysis of the Anterior Ethmoidal Artery Flap

“…To perform an AEA flap, the flap base is created along the dorsal septum via anterior and posterior incisions (Fig. 5), presumably to preserve a vascular pedicle of one or more vertically‐oriented AEA branches 8,12,13,22 . Surgeons may make the anterior incision at different locations based on the NSP location, but the incision is usually at or anterior to the level of the MT axilla, then carried vertically or diagonally to reach the posterior edge of the NSP.…”

“…Tumlin et al recently demonstrated 73% overall AEA flap success for NSPs. They identified active smoking, intranasal drug use, and diabetes mellitus as significant risk factors for surgical failure 22 . Future studies could explore whether wider AEA pedicles lead to improved success when repairing NSPs, especially for the previously mentioned risk factors.…”